ABSTRACT
OBJECTIVES: To evaluate the impact of baseline left ventricular (LV) function on the clinical outcomes of patients with functional mitral regurgitation (FMR) treated with MitraClip. BACKGROUND: It is unknown whether patients with significant FMR and severe LV dysfunction benefit from MitraClip. METHODS: A cohort of 77 patients with significant FMR undergoing MitraClip procedure between December 2010 and January 2015 was categorized by baseline LV ejection fraction (LVEF) into tertiles: LVEF <27% (n = 27), LVEF 27-37% (n = 25), and LVEF >37% (n = 25). We sought to evaluate the impact of LVEF on all-cause mortality at follow-up. RESULTS: There were no significant differences in baseline comorbidities, medical treatment and MR severity among tertiles of LVEF. Overall procedural success was 94%, with no differences among groups (LVEF <27%: 89%; LVEF 27-37%: 100%; LVEF >37%: 92%; P = 0.25). Median follow-up was 372 days (interquartile range: 128-627 days). MR severity improved in all three groups, as compared to baseline. There were no differences in the prevalence of MR ≤2+ on follow-up (P = 0.40). Mortality was highest in patients with LVEF <27% (41%), as compared with LVEF 27-37% (16%) and LVEF >37% (4%), P = 0.004. Patient who died had a lower baseline LVEF compared to those who survived (24.8 ± 7.7% versus 35.5 ± 13.7%, P < 0.001). An LVEF <27% was an independent predictor of mortality after adjusting for procedural success: hazard ratio 3.4 (95% CI: 1.1 to 10.0; P = 0.030). CONCLUSIONS: MitraClip is effective in FMR patients regardless of the severity of LV dysfunction. However, low baseline LVEF is associated with increased mortality, despite procedural success. © 2016 Wiley Periodicals, Inc.
Subject(s)
Cardiac Catheterization , Mitral Valve Insufficiency/therapy , Mitral Valve/physiopathology , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left , Aged , Aged, 80 and over , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Cardiac Catheterization/mortality , Female , Humans , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/mortality , Mitral Valve Insufficiency/physiopathology , Recovery of Function , Retrospective Studies , Risk Factors , Severity of Illness Index , Stroke Volume , Time Factors , Treatment Outcome , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/mortalityABSTRACT
The MitraClip (Abbott Vascular, Menlo Park, CA) is a device used to perform transcatheter edge-to-edge repair of the mitral valve approved by the Food and Drug Administration for the treatment of high-risk degenerative mitral regurgitation. We describe the follow up of a 78-year-old man with severe functional mitral regurgitation and cardiogenic shock who underwent a successful MitraClip implantation.
